Globally, tobacco use accounts for 4.9 million deaths each year. The contribution of cigarette smoking to this toll has been well-documented. However, millions smoke tobacco using other methods, including waterpipes ("hookah" or "shisha"). As the WHO notes, waterpipe tobacco smoking is spreading globally and has been associated with tobacco-caused disease. Global popularity and disease risk highlight the need to learn more about waterpipe smoking, including its regional prevalence and user toxicant exposure profile. They also highlight a worldwide need for tobacco-related research capacity. This capacity is particularly needed in the countries of Southwest Asia, where tobacco use rates can exceed 50% and waterpipe tobacco smoking is common. Some countries, like Syria and Lebanon, have been building tobacco research capacity [e.g., NIH- funded research at the Syrian Center for Tobacco Studies (SCTS) and the American University of Beirut (AUB)]. Others may require more research capacity before they can join regional tobacco research efforts. For example, Jordan has high tobacco use rates and waterpipe tobacco smoking seems common. Studying Jordanian waterpipe use prevalence and user toxicant exposure would provide needed local data while developing regional tobacco-related research capacity. This response to PAR-08-223 describes work to be completed primarily in Irbid, Jordan with Drs. Mohammed Azab and Omar Khabour of the Jordan University of Science and Technology (JUST), and is an extension of R01CA120142 (02-21-2008 to 01-31-2013). The three specific aims of that parent grant, which involves U.S. waterpipe tobacco smokers, are to: 1) learn about waterpipe smoke toxicant yield and user toxicant exposure and effects when an individual uses a waterpipe to smoke tobacco;2) learn how to group use influences waterpipe toxicant yields and effects, and 3) learn how the toxicant exposure and acute effects of waterpipe tobacco smoking differ from those of cigarette smoking. The specific aims of this grant application are to: 1) study, over three years, changes in waterpipe tobacco smoking prevalence, knowledge and beliefs among Jordanian university students;2) examine relationships among waterpipe users'dependence, smoking behavior, and CO exposure;and 3) enhance local and regional tobacco-related research capacity. Formal training opportunities (e.g., SCTS'International Summer Program for Tobacco Control Research;project-focused workshops in Years 1 and 2) will be supported by on-line collaboration and mentorship to develop capacity and foster long-term professional relationships. These relationships strengthen JUST, SCTS, and AUB separately while increasing regional capacity and encouraging future joint research activity. Thus, this project provides an opportunity to learn more about tobacco use in Jordan while strengthening that country's tobacco-related research capacity. In so doing, the project establishes a foundation for regional tobacco-related research while simultaneously addressing the aims of the parent grant regarding user toxicant exposure and extending them to include waterpipe prevalence rates. PUBLIC HEALTH RELEVANCE: This project is relevant to public health because waterpipe tobacco smoking is a little-understood but rapidly emerging strain in the global tobacco epidemic. The project will inform nascent efforts to prevent waterpipe tobacco smoking from contributing substantially to tobacco's morbidity and mortality by revealing the use prevalence and user toxicant exposure among Jordanian university students. Perhaps more important, the project builds Jordanian tobacco-related survey and laboratory research capacity while strengthening regional capacity and fostering international collaboration. The positive health impact of this type of research capacity and collaboration on tobacco cigarette smoking is well-documented;this project seeks similar positive outcomes on another potentially lethal form of tobacco use.